I'm doing ID consults this month and I'm finding it to be somewhat tedious. Most of the consults are interesting, there are exceptions of course with surgeons asking how to treat wound infections. Overall the content is stimulating. However, the staff I work with want to know every detail about the patient's history. Is this universally true? Do the rest of you who have done ID consults find that you really have to dig into the chart, sometimes becoming fatigued in doing so? For example, even if the consult is for antibiotic recs for a given bug, we end up hashing through everything sometime turning up minutiae that may indicate sources of other infection or just other disease processes in general.
Just wondering...

just finished doing ID consult elective, and even before even starting the rotation I had already heard about how most of what a person does on ID consult is doing a super-detailed chart biopsy. Most times the answer to the consult question (which is usually "how do we treat this osteomyelitis") that the consulting physician is interested in is simple. The reasons why they make sure they know all the details is to (1) make sure that the patient doesn't have a risk factor for having another pathogen which they are not currently covering for (2) make sure that the patient doesn't have risk factors for recurrence of the infection (in which case they would try to intervene) (3) rule-out any concomitant non-infectious processes that might be going on (so that they can anticipate the degree of response to anti-microbials)

ID docs and renal docs are the some of the smartest physicians in the hospital, and it is mainly due to their attention to detail.

enjoy ID

Yes. But if you're bored, consult both ID and Pulm on a HAP patient and watch them argue in the chart.

ID docs and renal docs are the some of the smartest physicians in the hospital, and it is mainly due to their attention to detail

Oh whatever :rolleyes: . . . attention to detail makes you anal NOT "smart" . . . and I'm not saying that anal retention is a bad thing . . .

The smartest guys in the hospital are probably the pathology guys as they laugh on the way in at 9PM and out at 4PM . . .

However, the staff I work with want to know every detail about the patient's history. Is this universally true?

Yes.

-The Trifling Jester

vote#2 for some of the smartest doctors in the hospital. While it's not my thing, I really really respect the ID docs at our hospitals.

I would say the answer to your question is "yes".
And I agree that ID docs and renal docs are among the smartest, or at least most intellectual, of the medicine docs.

My guess was that it was universally true that ID consults involve great detail. As one attending put it, "Our only invasive procedure we do is looking through the chart." I certainly think it's beneficial and that details are extracted that medicine and surgical teams aren't paying attention to. I just wish it could be a more expedient process. Obviously the requesting service greatly appreciates the consult because it gives more in depth of an H&P than anyone else has done. In fact, when admitting a patient one of the best things you can come across is an old ID consult--it's all there. You even have small talk you can make with the patient,
"So, how did you enjoy your trip to the Gulf Coast of Texas three years ago?"
"I understand you're a big fan of raw shellfish... "
"I also enjoy having small rodents in my home like ferrets and hamsters."
" So, you've had 5 sexual partners in the past year, both men and women--sounds like you're having more fun than I am..."

As an aside, don't you find it totally annoying when you leave recs as a consultant and no one reads them. Glad you asked us to come by so we can write pertinent recs each day that you ignore. :)

How do ID docs survive in the real world (outside of academic medicine)? Unless you find a niche in a high-volume HIV clinic, I would imagine it would be hard to make a decent living in the specialty. In private prac, ID docs are probably less detail oriented than in academics, but without a procedure and with it taking longer to see an ID pt than pts in other specialties, it seems like it would be hard to make a living in ID.

Word on the street is that if someone has been in-house for more than 1 month, the surgeons will call an ID consult for abx recs and read off the chart bx as their discharge summary.

Word on the street is that if someone has been in-house for more than 1 month, the surgeons will call an ID consult for abx recs and read off the chart bx as their discharge summary.

i read this and then I lol'd

1. look up rec on up to date.
2. write order for antibiotic.

ID consults are usually predictable and frequently tell you what you already know. We sometimes don't follow their recs anyway.

How do ID docs survive in the real world (outside of academic medicine)? Unless you find a niche in a high-volume HIV clinic, I would imagine it would be hard to make a decent living in the specialty. In private prac, ID docs are probably less detail oriented than in academics, but without a procedure and with it taking longer to see an ID pt than pts in other specialties, it seems like it would be hard to make a living in ID.

that seems to assume that private practice doc's stay on top/up to date on the latest topics. i won't pretend to throw out a number, but there are plenty of older primary attendings who either don't know some of the latest stuff, or aren't around enough (running between clinic and a few hospitals), or a combination of the two. throw in a few docs who will order an id consult as soon as a patient has a fever, and just for good measure, also throw in a few docs who will order a consult if the white count is the same two days in a row.

also, a hospital may have policies in place such that certain antibiotics can not be ordered without an official id consult.

depending on the hospital, it may not be so bad.

I just put everyone on imipenem. What's so hard about ID?

Word on the street is that if someone has been in-house for more than 1 month, the surgeons will call an ID consult for abx recs and read off the chart bx as their discharge summary.

Which is why any patient with an extended hospitalization, regardless of service (although ortho and trauma are far and away the biggest offenders here) who has an ID consult called the same day that a progress note reads "likely d/c home tomorrow" got the following note from me:

"X yo person w/ complicated hospitalization (please see primary team's daily PN for complete details) consulted for Y and Z."

I would then actually do the chart bx, note relevant details (essentially dates of procedures and culture results) in the consult note (while reporting complete results to the attending) and then give what the consult actually asked for, abx recs.

Seriously, if someone had ever been honest enough to actually ask for what they really wanted (a pre-packaged D/c Summary), I probably would have done it, just to make a point. Then I would have asked the ID attending to call the primary team chief of service, also just to make a point. Never had that opportunity though.

1. look up rec on up to date.
2. write order for antibiotic.

ID consults are usually predictable and frequently tell you what you already know. We sometimes don't follow their recs anyway.

hmmm?!?!? i thought the idea of the ID consult was getting recommendations on a difficult case: a situation for which there isn't a dedicated UpToDate article or where the 1st line antibiotic is contraindicated.
if you are getting consults on everything, then your ID division must love you because it charges per consult. keep it up.

Which is why any patient with an extended hospitalization, regardless of service (although ortho and trauma are far and away the biggest offenders here) who has an ID consult called the same day that a progress note reads "likely d/c home tomorrow" got the following note from me:

"X yo person w/ complicated hospitalization (please see primary team's daily PN for complete details) consulted for Y and Z."

I would then actually do the chart bx, note relevant details (essentially dates of procedures and culture results) in the consult note (while reporting complete results to the attending) and then give what the consult actually asked for, abx recs.

Seriously, if someone had ever been honest enough to actually ask for what they really wanted (a pre-packaged D/c Summary), I probably would have done it, just to make a point. Then I would have asked the ID attending to call the primary team chief of service, also just to make a point. Never had that opportunity though.

That's such weak sauce . . . and I thought the surgeons complained that medicine was lazy . . .

1. look up rec on up to date.
2. write order for antibiotic.

ID consults are usually predictable and frequently tell you what you already know. We sometimes don't follow their recs anyway.

then why are you wasting time asking for a consult?